Summer Edition 2019.
Authors: Amedee RG PMID: 31258415 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Expanding the Perisurgical Home to Improve Postoperative Pain Management and Reduce Opioid Consumption.
Authors: Urits I, Viswanath O, Orhurhu V, Cai V, Aner M PMID: 31258416 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

When Imagination Becomes a Disease: Dealing With Hypochondriacal Patients in Clinical Practice.
Authors: Mobley D, Baum NH, Beattie A, Nemeroff C PMID: 31258417 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Endovascular Therapy for Abdominal Pregnancy.
Authors: Frischhertz S, Eubanks-Bradley J, Gilbert P PMID: 31258418 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Bundling Interventions to Enhance Pain Care Quality (BITE Pain) in Medical Surgical Patients.
Conclusion: Medical surgical patients participating in this study who received the bundled 6-component intervention reported significantly higher levels of perceived pain care quality, suggesting that a bundled approach may be more beneficial than unstandardized strategies. PMID: 31258419 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Autograft vs Allograft Comparison in Pediatric Medial Patellofemoral Ligament Reconstruction.
Conclusion: This study supports the use of allograft for chronic patellar instability because of improved graft survivorship and clinical outcome scores, as well as the lower cost and reoperation rate. PMID: 31258420 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Superfluous Amylase/Lipase Testing at a University-Affiliated Teaching Hospital: A Retrospective Review.
In this study, 3,502 patients had 8,801 tests (4,926 lipase, 3,875 amylase), 4% of which were diagnostic and 10% borderline. Of the 8,801 tests, 45% were superfluous and 9% were questionably superfluous. Nonsuperfluous testing was less frequent (P
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Metaanalysis of Multivessel vs Culprit Artery Only Percutaneous Coronary Intervention in ST Elevation Myocardial Infarction.
Authors: Garcia DC, Benjo AM, White CJ, Cardoso RN, Macedo FYB, Schob AH, El-Hayek GE, Nadkarni GN, Aziz EF, Patel RAG Abstract Background: Primary percutaneous coronary intervention (PCI) is the most frequently used treatment modality for patients presenting with ST elevation myocardial infarction (STEMI). Current professional society guidelines recommend culprit artery only PCI. Recent evidence suggests the potential benefit of multivessel PCI among patients with STEMI that is not complicated by cardiogenic shock. Methods: We systematically searched PubMed, EMBASE, and the Cochrane Central Register of Controlled ...
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Acute Hematogenous Osteomyelitis in Children.
Conclusion: Given the evolution of pathogens, the variability in clinical presentations and course ranging from simple to complex disease, and response to treatment, the management of AHO continues to evolve and warrants an individualized, multidisciplinary approach. PMID: 31258423 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Congenital Cytomegalovirus Infection.
Conclusion: Congenitally acquired cytomegalovirus is found in all communities around the world with a disease burden that is greater than many other well-known diseases. Advances are being made in prevention and treatment; however, improved awareness of the disease among clinicians and patients is needed. PMID: 31258424 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Curative Therapies for Sickle Cell Disease.
Conclusion: Evaluation of the long-term benefits of curative therapies for SCD requires comparative clinical trials and studies of late effects. PMID: 31258425 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Limitations to the Therapeutic Potential of Tyrosine Kinase Inhibitors and Alternative Therapies for Kidney Cancer.
Conclusion: The treatment of RCC is undergoing a paradigm shift from sole use of small molecule antiangiogenesis TKIs as first-line therapy to include newly approved agents for second-line and third-line therapy that now involve the mTOR pathway and immune checkpoint blockade drugs for patients with advanced RCC. PMID: 31258426 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Iliopsoas Mass, Hydroureter, and Back Squats: Using Biomechanics and Diagnostic Persistence to Diagnose a Germ Cell Tumor.
Conclusion: The importance of a plausible differential diagnosis combined with clinical diagnostic persistence must be stressed to all clinicians. Our patient's unrelenting inguinal pain led to a justified repeat psoas mass biopsy, imaging, and laboratory workup that led to a diagnosis of psoas germ cell tumor and immediate chemotherapy plan. PMID: 31258427 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Endoscopic Retrieval vs Observation in Cylindrical Battery Ingestion.
Conclusion: Our case and review of the literature demonstrate that nonsurgical, conservative management with close clinical monitoring is possible in a hospital setting after cylindrical battery ingestion. Cases with concerning clinical symptoms or a history of damage to the battery casing warrant endoscopic or surgical intervention. PMID: 31258428 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Peritoneal Encapsulation With Incarcerated Meckel Diverticulum Contributing to Small Bowel Obstruction.
Conclusion: This patient had 3 rare findings-peritoneal encapsulation, Meckel diverticulum, and a mesodiverticular band-contributing to cause an acute small bowel obstruction. The presence of all of these features in one patient is extremely rare, and we believe this is the first description of such a phenomenon. PMID: 31258429 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Concurrent Persistent Cryptococcosis and Mycobacterium avium Complex Infections in a Patient With Human Immunodeficiency Virus.
Conclusion: Concurrent infection with cryptococcosis and MAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis. PMID: 31258430 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Extensive Abdominal Sarcoidosis Without Pulmonary Manifestation.
Conclusion: Extrapulmonary sarcoidosis is a rare disease, and intraabdominal sarcoidosis might mimic other malignant etiologies. We treated our case with laparoscopic removal of involved organs and oral steroids with significant recovery during a short period. PMID: 31258431 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Spontaneous Unilateral Tubal Twin Ectopic Pregnancy.
Conclusion: Healthcare providers should have a high index of clinical suspicion for ectopic pregnancies. Unilateral tubal twin ectopic pregnancies, while rare, can be adequately diagnosed with transvaginal ultrasound. Laparoscopic salpingostomy provides conservative and successful treatment of unilateral tubal twin gestation with short recovery time. Medical treatment with methotrexate has not been adequately studied in this clinical scenario, but further exploration of this management modality should be considered. PMID: 31258432 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Delayed Metastatic Melanoma to the Pharyngeal Tonsil in an African American Female.
Authors: Barton BM, Ramsey T, Magne JM, Worley NK Abstract Background: Metastatic melanoma to the mucosa of the upper aerodigestive tract is extremely rare, accounting for
Source: Ochsner Journal - July 3, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

An Emphasis on Neurosciences.
Authors: Amedee RG PMID: 30983890 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Intraabdominal Approach During Donation-After-Cardiac-Death Procurement May Offer a Simpler and Faster Way to Achieve Thoracic Aorta Cross-Clamp.
Authors: Graham JA, Patel G, Miura Y, Kinkhabwala M, Rocca JP PMID: 30983891 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Demographic Factors That Influence United States Medical Licensing Examination Scores.
Authors: Jawed S PMID: 30983892 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Growing Evidence for the Impact of Air Pollution on Depression.
Authors: Ali NA, Khoja A PMID: 30983893 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

How Much Anesthesia Research Has Academia in the United States Contributed in the Past 50 Years?
Authors: Abd-Elsayed A, Fiala K PMID: 30983894 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Transforming Growth Factor Beta 1 Regulates Fibroblast Growth Factor 7 Expression in Schwann Cells.
Authors: Nguyen D, Sulaiman OAR Abstract Background: Our previous work demonstrated that application of transforming growth factor beta 1 (TGF-β1) and forskolin to the repair site after chronic denervation and axotomy has a mitogenic effect, reactivates Schwann cells (SCs), and supports axonal regeneration. We found decreased expression of fibroblast growth factor 7 (FGF-7), a factor involved in synaptic organization and maintenance. Using an in vitro system, we examined the molecular mechanism of TGF-β1 and forskolin on the regulation of FGF-7 expression in SCs. Methods: SCs were prepared from the sciati...
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Comorbidities Related to Clinical Outcomes in Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: Review of Literature and Experience at a Single Comprehensive Stroke Center.
Conclusion: Hypertension, peripheral artery disease, and younger age at presentation are correlated with poor functional outcome in patients with acute ischemic stroke undergoing MT. PMID: 30983896 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Gadolinium Deposition in Neurology Clinical Practice.
Conclusion: Clear evidence demonstrates that GBCAs lead to gadolinium deposition in the brain in a dose-dependent manner; however, only linear GBCAs have been associated with gadolinium deposition visualized on MRI. To date, no evidence links gadolinium deposition with any adverse health outcome. Updated medical society guidelines emphasize the importance of an individualized risk-benefit analysis with each administration of GBCAs. PMID: 30983897 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Biomarkers of Pineal Region Tumors: A Review.
Conclusion: Serum and CSF biomarkers in conjunction with clinical and radiographic evidence of a pineal region mass can inform the decision whether to undertake stereotactic biopsy or surgical excision or whether to proceed straight to medical treatment. PMID: 30983898 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Sphenopalatine Ganglion Block and Radiofrequency Ablation: Technical Notes and Efficacy.
Conclusion: Targeting the SPG is a promising treatment option for refractory CHs. RFA and neuromodulation have the potential to offer long-term significant pain relief, but more randomized studies are needed to demonstrate their efficacy. PMID: 30983899 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Laminoplasty for Cervical Spinal Cord Stimulator Implantation in Patients With Cervical Spondylosis and Fusion: A Technical Note.
Conclusion: In addition to stabilizing the epidural paddle lead, laminoplasty offers several potential advantages compared to decompression alone. PMID: 30983900 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Novel Technique of Coregistered Intraoperative Computed Tomography and Preoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Navigation in Spinal Cord Tumor Resection.
Conclusion: The coregistration of preoperative MRI sequences and iCT images allowed for meaningfully enhanced navigation during resection. In the case involving the intramedullary cervicomedullary tumor with marked distortion of longitudinal tracts, iCT/DTI navigation allowed for accurate visualization of critical structures and facilitated delineation of tumor margins that otherwise would have been difficult. The use of combined iCT and preoperative MRI/DTI neuronavigational guidance is an effective approach in the resection of intradural extramedullary and intramedullary spinal cord tumors. PMID: 30983901 [PubMed] (S...
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Three-Dimensional Printed Patient Models for Complex Pediatric Spinal Surgery.
Conclusion: The anatomic complexity and risk of devastating neurologic consequences in spine surgery call for careful preparations. 3-D models enable more efficient and precise surgical planning compared to the use of 2-dimensional CT/magnetic resonance images. The 3-D models also make it easier to visualize patient anatomy, allowing patients and their families who lack medical training to interpret and understand cross-sectional anatomy, which in our experience, enhanced the consultations. PMID: 30983902 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Interhemispheric Paracallosal Approach for an Arteriovenous Malformation of the Atrium: A Novel Technique.
Conclusion: This case illustrates a novel variation to an established approach to the ventricular atrium. With this technique, the surgeon minimizes disruption of brain tissue and thereby avoids the associated postoperative deficits associated with traditional approaches (transcortical, transcingulate, and conventional transcallosal). Tractography studies and a large cohort of patients are necessary to ensure the reproduction of good outcomes. PMID: 30983903 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Anti-N-Methyl-D-Aspartate Receptor Encephalitis in a Patient With Antithyroid Peroxidase Antibodies and a Parotid Pleomorphic Adenoma.
Conclusion: This case demonstrates a typical presentation of anti-NMDA-R encephalitis, as well as the challenges that can delay diagnosis. Symptoms vary and are often psychiatric, making these patients difficult to diagnose clinically, and they therefore require thorough investigation. This case illustrates the necessity to be inquisitive and to challenge the diagnosis when a clinical picture is not congruent because an accurate diagnosis is imperative in guiding appropriate treatment. PMID: 30983904 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Carotid Web Stenting.
Conclusion: Although carotid webs are most commonly treated with endarterectomy, they may be amenable to stent therapy with favorable clinical outcomes as shown with this patient. PMID: 30983905 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - April 17, 2019 Category: General Medicine Tags: Ochsner J Source Type: research

Our Focus Is on the Children.
Authors: Warrier RP PMID: 30559608 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Impact of Airborne Pollutants on Stroke.
Authors: Khoja A, Kazim F PMID: 30559609 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Proper Sterile Gloving Technique for Non-Operating Room Sterile Procedures: A Step-by-Step Guide.
Authors: Viswanath O, Aner M PMID: 30559610 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Online Symptom Checker Applications: Syndromic Surveillance for International Health.
Authors: Berry AC PMID: 30559611 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Fundamentals of the Pediatric Consent Process in Louisiana.
Authors: Peairs A, Miceli M, White MG, Carollo DS PMID: 30559612 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Building a Bridge Between Primary and Perioperative Care: Addressing the Challenges of Perioperative Buprenorphine Maintenance and Postdischarge Therapy.
Authors: Urits I, Viswanath O, Petro J, Yazdi C PMID: 30559613 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Clinical Observations, Plasma Retinol Concentrations, and In Vitro Lymphocyte Functions in Children With Sickle Cell Disease.
Authors: Kuvibidila SR, Gardner R, Velez M, Warrier R Abstract Background: Children with sickle cell disease (SCD) often have infections, growth deficits, and impaired immunity, problems that also are observed in individuals with a vitamin A deficiency (plasma retinol concentration 0.1) than children who were not vitamin A-deficient. Lymphocyte proliferative responses negatively correlated with health score, pain crisis episodes, and blood units received, but positively correlated with retinol binding protein (P
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Parent and Child Reports of Food Insecurity and Mental Health: Divergent Perspectives.
Conclusion: Our data show that adults may not accurately perceive the subjective effects of food insecurity on children in their household, particularly in households receiving food assistance, perhaps because of objectively greater need. Because food insecurity may have profound effects on child development, pediatricians should be aware of the mental health risks for children in food-insecure homes. PMID: 30559615 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Comparison Between Pediatricians and Physicians in Other Medical Specialties in Promoting Smoking Cessation in the Clinic.
Conclusion: The physicians in other specialties showed consistently higher rates of confidence and performance of SCP behaviors than the pediatricians. Intervention is necessary to encourage pediatricians at Ochsner Health System to promote smoking cessation in their practices. PMID: 30559616 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Determination of Key Drivers of Patient Experience in a Midsize Pediatric Hematology-Oncology Ambulatory Clinic.
Conclusion: High provider ratings were most associated with the physician's ability to explain problems and conditions to families. Staff teamwork and nursing attitude were most associated with patient recommendations of the PHO practice. By identifying key drivers of high provider and practice ratings by patients in the PHO ambulatory setting, a targeted approach with a focus on physician-specific communication attributes, teamwork, and nursing attitude can be deployed to improve the patient experience. PMID: 30559617 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Oral Development and Pathology.
Conclusion: The embryology and anatomy of the oral cavity are complex, and the mouth is crucial to many physiologic processes. Pediatric primary care providers are uniquely positioned to prevent, identify, and triage dental caries, the most common chronic disease of childhood. PMID: 30559618 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Diagnosis of Tooth Agenesis in Childhood and Risk for Neoplasms in Adulthood.
Conclusion: Although odontogenesis and tumorigenesis may seem to be unrelated processes, the clinical association between the two highlights the overlap of genetic determinants and molecular pathways. Tooth agenesis can be diagnosed during childhood and should be considered a marker for risk of neoplasms in adulthood. Healthcare providers should identify tooth agenesis and provide appropriate anticipatory guidance. PMID: 30559619 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Dental Care for Patients With Childhood Cancers.
Conclusion: Childhood cancer survivors present with unique challenges for dental management because of dental anomalies caused by cancer therapy. Interprofessional collaborative care between the pediatric dentist and the oncologist during and after cancer therapy will enable best outcomes for the pediatric patient. In addition, dental professionals must be prepared to meet the unique needs of long-term cancer survivors because of the increasing survival rates of childhood cancers. PMID: 30559620 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Summer Camps for Children with Sickle Cell Disease.
Conclusion: Camp offers unique opportunities for care coordination. Camps for children with SCD provide a setting for dissemination of best practices for the disease. Community-based organizations should partner in recruiting young adults with SCD as counselors. Educational material now available could be modified for use in the camp setting. All stakeholders in the care of children with SCD should work in unison to ensure these children enjoy the benefits of summer camp. PMID: 30559621 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research

Can Nurturing the Young Be the Key to Tackling Chronic Diseases in the Old? A Narrative Review With a Global Perspective.
Conclusion: Tackling the epidemic of chronic diseases requires a comprehensive life course approach that must include pregnant women and their young children. Healthcare systems and professionals play an important role. The health and well-being of the next generation must be everyone's business. PMID: 30559622 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 20, 2018 Category: General Medicine Tags: Ochsner J Source Type: research